Sutra Sthana

Sutra Sthana

Sections
Succeeding	Nidana Sthana
First Tetrad (Bheshaja Chatushka)
Chapters	Deerghanjiviteeya Adhyaya, Apamarga Tanduliya Adhyaya, Aragvadhiya Adhyaya, Shadvirechanashatashritiya Adhyaya
Second Tetrad (Swastha Chatushka)
Chapters	Matrashiteeya, Tasyashiteeya, Naveganadharaniya, Indriyopakramaniya

Preamble of Sutra Sthana (Section on Fundamental Principles)

श्लोकस्थानं समुद्दिष्टं तन्त्रस्यास्य शिरः शुभम्

Shlokasthanam samuddishtam tantrasyasya shirah shubham [Cha. Chi. 30/45]

Per the above verse, the Sutra Sthana (Section on fundamental principles) of Charaka Samhita deserves the same place as the head deserves in the human body. In ancient times, the Sutra Sthana was always placed first among Samhitas(ancient reference texts of Ayurveda).Thus, this important section lays the foundation for the whole Charaka Samhita by means of the basic principles documented in it. Besides the foundation principles, this section also establishes various technical terms that are used in subsequent sections of the Charaka Samhita. This helps in providing a base to not just Ayurveda practitioners, but also teachers, researchers, and scholars. From the standpoint of its structure, the Sutra Sthana consists of thirty chapters, grouped into eight logical groupings. The first seven are Chatushkas(or tetrads, i.e., groups of four), while the last one is a sangrahadvaya(a group of two chapters). The first Chatushka is also known as Bheshaja or the Aushadha(medicine) Chatushka. This tetrad deals with various medicines to be used in various forms either externally or internally (i.e., bheshaja).

• The very first chapter of this chatushka(also the first chapter of the Charaka Samhita itself), the Deerghanjiviteeya Adhyaya, establishes technical concepts such as vata, pitta, kapha, rasa(taste), shat karana (six causes), etc. which are integral to Ayurveda and used extensively throughout Charaka Samhita. Besides these technical terms, the first chapter also describes various medicines, like Phalini Dravya (a group of drugs having therapeutically useful fruits), Moolini Dravya(a group of drugs having therapeutically useful roots), Mahasneha (four kinds of fats), Lavana(salts), various types of mutra(urine) and ksheera(milk). This chapter also emphasizes on the rational use of medications, since indiscriminate use of even good medicines can cause more harm than good. The chapter then goes on to explain the important concept of Trisutra (three principles ofAyurveda) i.e. hetu (causes), linga(sign and symptoms) and aushadha (medicine).
• The second chapter (Apamarga Tanduliya Adhyaya) of the Bheshaja Chatushka deals specifically with herbs and medicines to be used during and after Panchakarma (five methods of bio-purification). Thus, the first two chapters of this tetrad describe various medicines to be used internally.
• The third chapter (Aragvadhiya Adhyaya) advocates the use of topical medications, or medicines to be applied externally, i.e.,lepa(topical medicines, etc).
• The fourth chapter (Shadvirechanashatashritiya Adhyaya) provides details of fifty Mahakashaya(or five classes of groups of ten medicines, and six hundred evacuatives) to be used in various diseases. Overall, this Chatushka provides a list of drugs to be used in various forms in a variety of diseases.

The second tetrad is the Swastha Chatushka that deals with important guidelines to be followed by healthy individuals to maintain their health.

• The first chapter of this tetrad, Matrashiteeya, deals with the daily regimen to be followed by healthy individuals to maintain their health.
• The next chapter, Tasyashiteeya, recommends changes one should make in his/her daily habits and lifestyle i.e. clothing, food habits, exercise etc., depending upon the season, to stay healthy.
• The seventh chapter in the Charaka Samhita, Naveganadharaniya, explains the importance of suppressible and non-suppressible urges in the human body, diseases due to non-suppressible urges and their treatment.
• Indriyopakramaniya is the last chapter in this tetrad, dealing with sadvritta (general code of conduct). Besides maintaining his own health, sadvritta also helps the individual in maintaining healthy relations with other individuals, thus helping maintain harmony in the society at large.

The third tetrad, Nirdesha Chatushka, is about instructions to health care providers.

• The first chapter of this Chatushka, Khuddakachatushpada, deals with the Chikitsa Chatushpada (or the Four Pillars of Therapeutics) - vaidya (physician), dravya (medicine), upasthata (nurse) and rogi(patient). Four qualities of each of these “pillars” and the importance of the physician amongst all of them have been detailed in this chapter.
• The next chapter, Mahachatushpada, explains the classification of diseases on the basis of prognosis. It is recommended in this chapter that the treatment should only be initiated after thorough diagnosis and identification of the disease, and the physician should refrain himself from treating the incurable diseases.
• The third chapter in this Chatushka (Tistraishaniya) deals with topics such as the three types of desires, strength, causes of diseases, diseases themselves, paths, physicians, and therapies.
• The last chapter of this tetrad (Vatakalakaliya) deals with the good and bad qualities/functions of vata, pitta, and kapha. A physician should have a thorough knowledge of the guidelines provided in this Chatushka to succeed in his field.

The next tetrad in Sutra Sthana, Kalpanachatushka, deals with the application of medicines in the form of various procedures either in healthy or in diseased individuals. Shodhana (bio-purification procedures) is an important concept of Ayurveda prescribed for removal of toxic wastes from the body. To prepare the patient for shodhana, he has to go through specific pre-shodhana procedures, such as snehana(internal application of sneha (fat)) and swedana(sweating), to mobilize toxic wastes within the body and excrete them out of the body.

• The first chapter of this Chatushka, Snehadhyaya, provides the guidelines for proper use of sneha either for shodhana or for shamana (to appease/palliation) purposes. A patient who has successfully completed the snehana procedure is now subjected to swedana procedure.
• The next chapter, Swedadhyaya, explains the various types of swedana recommended for various diseases. Snehana and swedana help the toxins to move towards the gut from where they will be expelled out of the body either through vamana(medicated emesis) or virechana(medicated purgation).
• The next chapter, Upakalpaniya, emphasizes on how a physician should be well equipped before administering any shodhana procedure to any of the patients. This chapter provides the outline for a fully equipped hospital and standard vamana and virechana procedures. The last chapter of this tetrad, Chikitsaprabhritiya, depicts the importance of shodhana over shamana therapy. The details of properly / improperly administered shodhana procedures are discussed here. Important concepts like shuddhachikitsa (pure form of treatment)and svabhavoparamavada(theory of natural destruction) etc. have also been described in this chapter.

The fifth Chatushka is about roga (disease). As the name suggests, this Chatushka provides a (brief) list of diseases that are extensively mentioned throughout Charaka Samhita.

• The first chapter Kiyanta Shiraseeya, provides the details of diseases like shiroroga(diseases of the head), hridroga(cardiac diseases), eighteen types of kshaya(loss of body tissues), vidradhi (abscess) and madhumeha(a clinical condition similar to diabetes mellitus).
• The next chapter, Trishothiya, elucidates various types of edema. The third chapter of this tetrad, Ashtodariya, reveals the types of about 48 diseases that are caused by a combination of doshas. The last chapter of this tetrad, Maharoga, is exclusively dedicated to the diseases caused by single doshas(vata, pitta, or kapha).

The sixth Chatushka, Yojanachatushka, deals with aspects of treatment of various diseases.

• The first chapter of this tetrad, Ashtauninditiya, describes eight types of people who are marginalized (or ridiculed) in the society due to their physical features. Out of these eight, only two i.e. atisthoola (morbidly obese) and atikrisha (emaciated) are described in detail because of their clinical significance along with their symptomatology and treatment.
• The next chapter, Langhanabrimhaniya, describes six types of treatment i.e. langhana(fasting), brimhana(nourishing therapy), snehana, svedana, rukshana(medical treatment for reducing fat/corpulence) and stambhana(astringent therapy) – primarily for managing atisthoola or atikrisha conditions, but also indicated for various other conditions described later in Charaka Samhita. Out of these six, mainly two therapies i.e. langhana and brimhana have been described in greater detail.
• The third chapter, Santarpaniya, deals with diseases caused due to over-nourishment or malnourishment along with their treatment.
• The last chapter of this Chatushka, Vidhishonitiya, deals with diseases that are not cured by any of the above-mentioned therapies and termed as diseases due to vitiation of rakta (blood). Such diseases, along with their etiology, symptomatology and treatment have been described in this chapter. Overall this Chatushka deals with all types of treatment modalities that find extensive reference across Charaka Samhita.

The last Chatushka of the Sutra Sthana is Annapana Chatushka.

• The first chapter, Yajjah Purushiya, brings forth the important perspective of the origin of human beings and the origin of diseases. This chapter also describes 155 entities (Agrya,or entities considered best in their category of drugs, food articles, bio-purification procedures, etc.)that are important for healthy as well as diseased individuals.
• The next chapter Atreyabhadrakapyiya, describes in detail the concept of Ayurvedic pharmacology in the form of rasa (taste), veerya(drug potency), and vipaka(final conversion of food/drug after the action of jatharagni(digestive power) and prabhava(specific action of a drug). This chapter also throws light on the important concept of viruddha ahara(incompatible diet) which seems to be the primary cause of many diseases even today.
• The third chapter, Annapanavidhi, provides details of Ayurvedic dietetics. This chapter details a wide variety of food and drinks, along with their medicinal values.
• The last chapter, Vividhashitapitiya, deals with important concepts such as formation of body tissues from the diet consumed, immunity and immune-compromised individuals, diseases originated from various body tissues, and migration of dosha from shakha(periphery or the tissue elements) to koshtha(central part of the body or alimentary tract)and vice versa.

The last two chapters are termed as Sangrahadvaya.

• The first of these two chapters, Dashapranayataneeya, deals with the ten locations in the human body where Prana(life) resides. Besides this important concept, the chapter also details the attributes of a pranabhisaravaidya(a physician who protects the life) and a rogabhisaravaidya (a physician who aggravates the disease and takes away the life of the patient).
• The last chapter of Sutra Sthana, Arthedashmahamooliya, deals with a variety of subjects such as the importance of Arth (hridaya-heart), ten major blood vessels or channels from the heart, the definition of ayu (combination of four entities i.e. body, mind, soul and senses) and its four types, Ayurveda, the aim of Ayurvedic science,and its method of study etc.

The name of each chapter of Sutra Sthana has its own significance. It either describes the main content of the chapter, the first topic described in that chapter, or the first word of that chapter. All the chapters are written in the same prose and poetry format. Each chapter ends with a summarizing verse or Tatrashloka(chapter summary). In some places, the prose is followed by poetry describing the same topic, such as Bhavati Cha Atra(the topic first described in prose is then described in poetry format). Various parameters have been used while constructing the shlokas of the Sutra Sthana, denoting the command of the author over Sanskrit. The chapters of Charaka Samhita are written in various styles, including as a dialogue (or a question-answer session) between the sage Atreya and his protégé, Agnivesha, or discussions among an assembly of sages. In fact, on reading the Charaka Samhita, one can find four type of sutras - Guru sutras (by the sage Atreya), Shishyasutras (by Agnivesha, the disciple or shishya of Atreya), Pratisankartu sutras (by Charaka), and Ekiyasutras(anonymous).

Like in most sections of the Charaka Samhita, the Sutra Sthana also reads as a free-flow text, with each chapter linked logically with the preceding and succeeding chapters in some way.